退行性半月板撕裂患者理疗与关节镜下手术疗效的前瞻性比较研究

A prospective and comparative study of either physiotherapy along or accompanied arthroscopic surgery for degenerative meniscal tears

目的评估针对退行性半月板撕裂,联合关节镜手术与理疗疗效是否优于单纯理疗。方法40例年龄>50岁,经磁共振(MRI)确诊为半月板撕裂患者根据数字随机法分为两个治疗组。一组接受关节镜手术治疗(关节镜手术+理疗组)20例,术后实施物理治疗;另一组接受单纯物理治疗方案(物理治疗组)20例。治疗方案完成后6、12、24个月,比较两组在膝关节损伤与骨关节炎评分(knee injury and osteoarthritis outcome score,KOOS)方面的差异。结果治疗后6个月,手术治疗组和物理治疗组疼痛、运动和娱乐、日常活动和KOOS总分评分均较术前明显改善,差异有统计学意义,其中物理治疗组疼痛由术前46.35改善至40.10(P<0.001)、运动和娱乐21.45上升至42.60(P<0.0001)、日常活动由27.85上升至41.75(P<0.0001)、KOOS总分从26.12提高至46.85(P<0.0001);镜下手术组疼痛由47.05改善至33.25(P<0.0001)、运动和娱乐由21.55上升至38.10(P=0.002)、日常活动由26.00上升至46.84(P<0.0001)、KOOS总分由23.05上升至39.26(P<0.0001)。治疗后12个月与6个月相比,临床症状进一步缓解,差异有统计学意义,物理治疗组疼痛降至29.20(户<0.0001)、运动和娱乐(P=0.007)、日常活动(P<0.0001)、KO(OS总分(P=0.001)分别上升至53.16、53.10、50.90;镜下手术组疼痛降至24.55(P<0.001)、运动和娱乐(P<0.0001)、日常活动(P<0.0001)、KOOS总分(P<0.0001)分别改善至54.10、57.65、50.77。治疗后24个月,患者各项评分与术后12个月基本持平。不同随访阶段,尽管手术组整体评分优于物理治疗组,差异并无统计学意义(P>

Objective To evaluate whether physiotherapy along was superior to physical therapy accompanied by arthroscopic surgery in the treatment of degenerative meniscal tears. Methods A total of 40 patients of more than 50 years old were diagnosed as meniscal tears based on Magnetic Resonance Imaging （ MRI ）, and then were divided into 2 treatment groups. The patients in the physical therapy accompanied by arthroscopic surgery group （ n=20 ） received arthroscopic surgery and then postoperative physical therapy, and the patients in the physical therapy group （ n=20 ） received physical therapy alone. The differences in the Knee Injury and Osteoarthritis Outcome Score （ KOOS ） were compared between the 2 groups at 6, 12 and 24 months after the treatment. Results At 6 months after the treatment, the pain, sports and entertainment, daily activities and KOOS scores both in the physical therapy accompanied by arthroscopic surgery group and in the physical therapy group were obviously improved when compared with the preoperative scores, and the differences between them were statistically significant. In the physical therapy group, the pain scores was improved from 46.35 points to 40.10 points （ P〈0.001 ）, the sports and entertainment scores from 21.45 points to 42.60 points （ P〈0.0001 ）, the scores of daily activities from 27.85 points to 41.75 points （ P〈0.0001 ） and the total KOOS from 26.12 points to 46.85 points （ P〈0.0001 ）. In the physical therapy accompanied by arthroscopic surgery group, the pain scores was improved from 47.05 points to 33.25 points （ P〈0.0001 ）, the sports and entertainment scores from 21.55 points to 38.10 points （ P=0.002 ）, the scores of daily activities from 26.00 points to 46.84 points （ P〈0.0001 ） and the total KOOS from 23.05 points to 39.26 points （ P〈0.0001 ）. The clinical symptoms at 12 months after the treatment were further improved when compared with that at 6 months after the treatment, and the differences between them were statistically significant. In the physical therapy group, the pain scores was changed to 29.20 points （ P〈0.0001 ）, the sports and entertainment scores to 53.16 points （ P=0.007 ）, the scores of daily activities to 53.10 points （ P〈0.0001 ） and the total KOOS to 50.90 points （ P=-0.001 ）. In the physical therapy accompanied by arthroscopic surgery group, the pain scores was changed to 24.55 points （ P〈0.001 ）, the sports and entertainment scores to 54.10 points （ P〈0.0001 ）, the scores of daily activities to 57.65 points （ P〈0.0001 ） and the total KOOS to 50.77 points （ P〈0.0001 ）. The scores of various items at 24 months after the treatment were almost equal to the scores at 12 months after the treatment. Although the overall scores in the physical therapy accompanied by arthroscopic surgery group were superior to that in the physical therapy group at different follow- up stages, the differences between them were not statistically significant （ P〉0.05 ）. Conclusions During the 2-year follow-up, no statistically significant differences are found in the functional improvement or pain relief between the 2 groups. Physical therapy should be considered as the preferred treatment choice for degenerative meniscal tears.